Traditional wound closure methods, such as staples and sutures, have numerous drawbacks, including the possible occurrence of inflammation, irritation, infection, wound gape, and leakage. In corneal applications, sutures often produce astigmatism due to uneven suture tension. The cosmetic results of the use of staples and sutures can also be undesirable.
Possible alternatives to sutures include hemostatic adhesives, such as fibrin sealants (Henrick et al. (1987) J Cataract Refract Surg 13:551-553; Henrick et al. (1991) J Cataract Refract Surg 17:551-555), cyanoacrylate adhesives (Shigemitsu et al. (1997) International Ophthalmology 20:323-328), and photodynamic tissue glue, composed of a mixture of riboflavin-5-phosphate and fibrinogen, which has been reported to close cataract incisions and attach donor cornea in corneal transplants (Goins et al. (1997) J Cataract Refract Surg 23:1331-1338; Goins et al. (1998) J Cataract Refract Surg 24:1566-1570; U.S. Pat. No. 5,552,452). In addition, temperature-controlled tissue welding has been attempted in bovine cornea and rat intestine (Barak et al. (1997) Surv Ophthalmol 42 Supp.1:S77-81; Cilesiz et al. (1997) Lasers Surg Med 21:269-86). Photochemical tissue welding of dura mater has also been reported, using 1,8 naphthalimides irradiated with visible light (Judy et al. (1993) Proc. SPIE-Int. Soc. Opt. Eng. 1876:175-179).
The ideal technique for wound closure would be simpler, more rapid, and prone to fewer post operative complications than conventional techniques. In the cornea, an ideal tissue repair or wound closure technique would produce a watertight seal without inducing astigmatism.